Browsing by Author "Moktan, Sushila Lama"
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Publication Cesarean Section under General Anesthesia over 10 Years at Tertiary Care Center: A Descriptive Cross-sectional Study(Nepal Medical Association, 2024) Basnet, Smriti; Lekhak, Prabineshwor Prasad; Subedi, Prabin; Moktan, Sushila LamaAbstract Introduction: The global surge in cesarean deliveries necessitates safe anesthetic practices to optimize outcomes. While the neuraxial block is the preferred method, specific conditions warrant general anesthesia. This study is aimed to determine the prevalence of cesarean sections under general anesthesia at a tertiary care center. Methods: A descriptive cross-sectional study was conducted on cesarean sections performed between April 14, 2013, and April 13, 2023, at a tertiary care center. Ethical approval was obtained from the Institutional Review Committee (Reference number: 20092023/01). Total sampling was done. Data for the past ten years were manually collected from hospital records using a self-structured proforma and analyzed using Microsoft Excel 2018 and IBM SPSS version 26. The point estimate and 95% confidence interval were calculated for the study. Results: In this study, there were 216 (2.98%) (95% CI: 2.59-3.38%) cesarean sections under general anesthesia in 10 years. Notably, among them, there were 103 (47.69%) primigravida, nullipara 130 (60.19%), 135 (62.50%) with no living children, and 161 (74.54%) without any past abortions. In most cases, 182 (84.26%) were emergency procedures and 34 (15.74%) were elective. Fetal bradycardia with distress was the primary indication observed in 121 (56.02%) cases, followed by 32 (14.81%) maternal requests. Additionally, twenty-one cases were found initially planned as cesarean sections under subarachnoid block but were converted to general anesthesia. The prevalence in this study was found within the recommended limits. Conclusions: The findings highlight that the majority of these procedures were emergency cases, predominantly due to fetal distress, with a notable proportion involving primigravida and nulliparous women.Publication Ultrasonographic Measurement of Skin to Lumbar Epidural Space Depth in Pregnant Women Undergoing Elective Cesarean Section: An Observational Study(Nepal Medical Association, 2025) Moktan, Sushila Lama; Thapa, Milan Kumar; Shrestha, Ujma; Subedi, PrabinAbstract Introduction: Neuraxial anesthesia is commonly used during cesarean delivery and is preferred for its effectiveness and minimal risks. Accurate identification of the depth of the lumbar epidural space is crucial to ensure successful block and minimize complications. However, this can be challenging in pregnant women due to physiological changes that affect the anatomy of the lumbar spine. Ultrasound is a helpful device for providing real-time visualization of the relevant anatomical structures and facilitating accurate needle insertion. In this study, we evaluated the utility of ultrasound in determining the depth from the skin to the lumbar epidural space in pregnant women undergoing elective caesarean section. Methods: This is an observational cross-section study performed after approval from Institutional Review Committee (Reference number:09062023/03). Using a curvilinear ultrasound probe, imaging of spine at lumbar third and fourth intervertebral space was performed. The measurements were performed in the sitting position with the patients' backs flexed in the parasagittal oblique and transverse median view to determine the distance from the skin to the lumbar epidural space. Results: The mean depth from the skin to the lumbar epidural space/posterior complex in the parasagittal oblique view was 46.84±7.18 mm (95% CI: 45.48-48.20), and transverse median view was 45.27±8.16mm (95% CI: 43.73-46.81). Conclusions: The skin-to-lumbar epidural space depth in pregnant women undergoing elective cesarean section was comparable to other studies conducted in similar settings.Publication Ultrasound Guided Trigger Point Injection and Sciatic Nerve Hydrodissection for Atypical Piriformis Syndrome: A Case Report(Nepal APF Hospital, 2026) Pun, Iswar Kumar; Amatya, Shirish Prasad; Moktan, Sushila Lama; Lamichhane, Suraj; Pun, InshaAbstract: Introduction : Chronic low back pain is a common complaint and is often attributed to lumbar disc disease. Less recognized causes, such as piriformis syndrome, can be overlooked, especially when routine tests and imaging are inconclusive. Early accurate diagnosis and targeted therapy are essential for effective pain relief. Case presentation: A 39-year-old male experienced six years of atraumatic low back pain radiating to his left leg and sole, worsening over 10 days and aggravated by prolonged sitting or standing. Examination revealed left piriformis tenderness but negative provocative tests, with minimal sensory deficit in the left L5 dermatome. Imaging showed a lumbarisation of sacral vertebra and L4–L5 disc bulge with bilateral lateral recess narrowing causing indentation of L4 exiting nerve root, which did not fully explain his symptoms. He had previously tried physiotherapy, oral steroids, neuromodulators, and analgesics without relief. Ultrasound-guided piriformis trigger point injection and sciatic nerve hydrodissection provided rapid and significant pain relief, confirming the piriformis as the primary pain source. Conclusion: This case highlights the diagnostic and therapeutic utility of ultrasound-guided, safe, and minimally invasive interventions in atypical piriformis syndrome refractory to conservative management.